scholarly journals Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes

Medicines ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 16
Author(s):  
Gabriele Savioli ◽  
Iride Francesca Ceresa ◽  
Luca Caneva ◽  
Sebastiano Gerosa ◽  
Giovanni Ricevuti
Keyword(s):  
Major Trauma ◽  
Management Strategies ◽  
Medical Problem ◽  
Current Evidence ◽  
Potential Drug ◽  
The Past ◽  
Trauma Induced Coagulopathy ◽  
Threatening Condition ◽  
Life Threatening ◽  
Trauma Mortality

Coagulopathy induced by major trauma is common, affecting approximately one-third of patients after trauma. It develops independently of iatrogenic, hypothermic, and dilutive causes (such as iatrogenic cause in case of fluid administration), which instead have a pejorative aspect on coagulopathy. Notwithstanding the continuous research conducted over the past decade on Trauma-Induced Coagulopathy (TIC), it remains a life-threatening condition with a significant impact on trauma mortality. We reviewed the current evidence regarding TIC diagnosis and pathophysiological mechanisms and summarized the different iterations of optimal TIC management strategies among which product resuscitation, potential drug administrations, and hemostatis-focused approaches. We have identified areas of ongoing investigation and controversy in TIC management.

scholarly journals Risk stratification in cardiogenic shock: a focus on the available evidence

2021 ◽  
Author(s):  
C. Sciaccaluga ◽  
G. E. Mandoli ◽  
N. Ghionzoli ◽  
F. Anselmi ◽  
C. Sorini Dini ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Cardiogenic Shock ◽  
Clinical Syndrome ◽  
Diagnostic Assessment ◽  
Prognostic Scores ◽  
Current Evidence ◽  
Efficient Resource ◽  
Threatening Condition ◽  
Life Threatening ◽  
Future Direction

AbstractCardiogenic shock is a clinical syndrome which is defined as the presence of primary cardiac disorder that results in hypotension together with signs of organ hypoperfusion in the state of normovolaemia or hypervolaemia. It represents a complex life-threatening condition, characterized by a high mortality rate, that requires urgent diagnostic assessment as well as treatment; therefore, it is of paramount important to advocate for a thorough risk stratification. In fact, the early identification of patients that could benefit the most from more aggressive and invasive approaches could facilitate a more efficient resource allocation. This review attempts to critically analyse the current evidence on prognosis in cardiogenic shock, focusing in particular on clinical, laboratoristic and echocardiographic prognostic parameters. Furthermore, it focuses also on the available prognostic scores, highlighting the strengths and the possible pitfalls. Finally, it provides insights into future direction that could be followed in order to ameliorate risk stratification in this delicate subset of patients.

Ossification of the Peritoneal Membrane

2004 ◽  
Vol 24 (5) ◽  
pp. 471-477 ◽  
Author(s):  
Nicola Di Paolo ◽  
Giovanni Sacchi ◽  
Paola Lorenzoni ◽  
Enrico Sansoni ◽  
Enzo Gaggiotti
Keyword(s):  
Histopathological Examination ◽  
Giant Cells ◽  
Peritoneal Membrane ◽  
The Past ◽  
Biopsy Specimens ◽  
Dialysis Solution ◽  
Threatening Condition ◽  
Life Threatening ◽  
Great Availability ◽  
White Material

Background Peritoneal dialysis (PD) patients rarely develop sclerosing peritonitis (SP), a severe, life-threatening condition of unknown pathogenesis. Ossification of the peritoneum (PO) is a rare occurrence, which has, however, been reported in PD patients with SP. Objective To investigate etiopathogenetic correlations between PO and SP by histopathological examination. Method We examined biopsy specimens, obtained by laparoscopy or during surgery from 36 patients with SP, from all parts of Italy in the past 8 years for evidence of peritoneal calcification or ossification. Other studies were performed on a sample of dense white material found under the parietal peritoneum of 1 patient during laparoscopy. Results Ossification of the peritoneum was found in 4/16 patients with calcifications. In addition to PO, we also found bone marrow in two specimens and arterial ossification in one case. In specimens with calcifications, and especially those with ossification, there was evidence of peritoneal inflammation with infiltration of lymphocytes, multinuclear giant cells, macrophages, and mast cells. The chemical composition of the whitish material was 85% calcium chloride and 15% hydroxyapatite. Conclusions Calcifications alone were found in 33% (12/36) of cases of SP; 11% of SP cases were complicated by both peritoneal calcification and ossification (4/36), which indicates great availability of calcium under conditions of inflammation. Where does this calcium come from? In 1 patient with PO, the quantity of calcium was enormous and its unusual composition suggested a link with the calcium contained in dialysis solution.

scholarly journals Pervasive refusal syndrome in asylum-seeking children: Review of the current evidence

2019 ◽  
Vol 25 (1) ◽  
pp. 227-241 ◽  
Author(s):  
Thinh Ngo ◽  
Matthew Hodes
Keyword(s):  
Asylum Seekers ◽  
Mental Health Disorder ◽  
Current Evidence ◽  
Post Traumatic Stress ◽  
Moderating Factors ◽  
Pervasive Refusal Syndrome ◽  
Third Stage ◽  
Foreign Policies ◽  
Threatening Condition ◽  
Life Threatening

This study reviews the current evidence in pervasive refusal syndrome (PRS) in asylum-seeking children. Refugees can experience a variety of traumas throughout the process of migration. Children can be exposed to multiple traumas such as experienced or witnessed physical or sexual violence, loss and bereavement, parental separation and the threat of persecution and/or kidnapping. The third stage of the migration journey can add further stress; children and families may experience multiple rejections of asylum application effectively living in limbo with the constant threat of deportation. High rates of mental health disorder are well documented in young asylum seekers, particularly depression, anxiety and post-traumatic stress disorder (PTSD). PRS is less frequently described but nonetheless a severe and life-threatening condition affecting young asylum seekers. Traumatisation, cultural factors and hostile asylum processes are specific moderating factors seen in asylum-seeking children. Asylum-seeking children normally make a full recovery from PRS. This study suggests a link between prolonged asylum processes and hostile foreign policy in developing and maintaining illness; similar cases are now being reported in other countries with hostile foreign policies. These findings are therefore relevant to clinicians and politicians working with this vulnerable group.

scholarly journals Repeated Sepsis in an 83-Year-Old Man With Cancer With Long-Lasting Invasive Treatments

2020 ◽  
Author(s):  
Masoomeh Imanipour ◽  
Nasrin Rasoulzadeh ◽  
Amin Hosseini
Keyword(s):  
Risk Factors ◽  
Immune Response ◽  
Immune System ◽  
Antibiotic Therapy ◽  
Major Trauma ◽  
Fluid Replacement ◽  
Underlying Condition ◽  
Threatening Condition ◽  
Life Threatening ◽  
Inflammatory Immune Response

Sepsis is a life-threatening condition that arises when the body's response to infection damages its own tissues and organs. Sepsis is caused by an inflammatory immune response triggered by an infection. Its risk factors include aging, weak immune system, major trauma, or burns. Treatment of sepsis is often based on fluid replacement and antibiotic therapy. In this study, an 83-year-old man is reported with two times of diagnosis of sepsis during three years. The first sepsis was due to an infection of the colostomy and the second one followed an infection at tracheostomy site. It seems that the disease and the underlying condition of the patient contribute to the occurrence of sepsis. The patient each time was discharged from the hospital after successful response to the treatment

scholarly journals Targeting Neutrophils in Sepsis: From Mechanism to Translation

2021 ◽  
Vol 12 ◽  
Author(s):  
Xiaofei Shen ◽  
Ke Cao ◽  
Yang Zhao ◽  
Junfeng Du
Keyword(s):  
Therapeutic Strategy ◽  
Secondary Infection ◽  
Specific Treatment ◽  
Neutrophil Function ◽  
The Past ◽  
Extracellular Traps ◽  
Promising Strategy ◽  
Threatening Condition ◽  
Life Threatening

Sepsis is a life-threatening condition caused by a dysregulated host response to infection. Although our understanding in the pathophysiological features of sepsis has increased significantly during the past decades, there is still lack of specific treatment for sepsis. Neutrophils are important regulators against invading pathogens, and their role during sepsis has been studied extensively. It has been suggested that the migration, the antimicrobial activity, and the function of neutrophil extracellular traps (NETs) have all been impaired during sepsis, which results in an inappropriate response to primary infection and potentially increase the susceptibility to secondary infection. On the other hand, accumulating evidence has shown that the reversal or restoration of neutrophil function can promote bacterial clearance and improve sepsis outcome, supporting the idea that targeting neutrophils may be a promising strategy for sepsis treatment. In this review, we will give an overview of the role of neutrophils during sepsis and discuss the potential therapeutic strategy targeting neutrophils.

Gastrointestinal Bleeding in Congenital Bleeding Disorders

2022 ◽  
Author(s):  
Amir Samii ◽  
Mahshaad Norouzi ◽  
Abbas Ahmadi ◽  
Akbar Dorgalaleh
Keyword(s):  
Gastrointestinal Bleeding ◽  
Management Strategies ◽  
Coagulation Factor ◽  
Bleeding Disorders ◽  
Individual Factor ◽  
Threatening Condition ◽  
Potential Risk Factors ◽  
Risk Patients ◽  
Life Threatening ◽  
Management Approaches

AbstractGastrointestinal bleeding (GIB) is serious, intractable, and potentially life-threatening condition. There is considerable heterogeneity in GIB phenotypes among congenital bleeding disorders (CBDs), making GIB difficult to manage. Although GIB is rarely encountered in CBDs, its severity in some patients makes the need for a comprehensive and precise assessment of underlying factors and management approaches imperative. Initial evaluation of GIB begins with assessment of hematological status; GIB should be ruled out in patients with chronic anemia, and in presentations that include hematemesis, hematochezia, or melena. High-risk patients with recurrent GIB require urgent interventions such as replacement therapy for treatment of coagulation factor deficiency (CFD). However, the best management strategy for CFD-related bleeding remains controversial. While several investigations have identified CBDs as potential risk factors for GIB, research has focused on assessing the risks for individual factor deficiencies and other CBDs. This review highlights recent findings on the prevalence, management strategies, and alternative therapies of GIB related to CFDs, and platelet disorders.

scholarly journals Acute respiratory distress syndrome: An update and review

2018 ◽  
Vol 6 (2) ◽  
pp. 74-77 ◽  
Author(s):  
Gautam Rawal ◽  
Sankalp Yadav ◽  
Raj Kumar
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Rescue Therapy ◽  
Severe Hypoxemia ◽  
Low Tidal Volume ◽  
The Past ◽  
Threatening Condition ◽  
Life Threatening

Abstract Acute respiratory distress syndrome (ARDS) is a life threatening condition characterized by severe hypoxemia due to pulmonary gas exchange failure and was first recognized in 1960s.Since its first description, it has undergone intensive research in the past few decades to understand its pathogenesis and therapies. Despite this, the recommended therapies to decrease mortality in ARDS remain limited and include low-tidal volume mechanical ventilation, prone ventilation and recently, the ECMO rescue therapy in extreme cases. This review article will summarize the key features of ARDS with a brief overview of the therapeutic options in the management of ARDS.

Pulmonary embolism as a potential side effect of olanzapine and the possible beneficiary side effect of duloxetine: A case study

2011 ◽  
Vol 26 (S2) ◽  
pp. 1222-1222
Author(s):  
O. Andrioti ◽  
N. Nikolaidis ◽  
S. Ntonias
Keyword(s):  
Pulmonary Embolism ◽  
Side Effect ◽  
Potential Effect ◽  
Protective Role ◽  
Psychiatric Medication ◽  
Male Smoker ◽  
The Past ◽  
Threatening Condition ◽  
Life Threatening

IntroductionPulmonary embolism is a very serious, life threatening condition. It has been associated with the use of antipsychotic drugs, both typical and atypical, thus consisting a rare but potentially lethal side effect of this drug category. SSRIs/SNRIs on the other hand, are associated with bleeding, increased INR results and platelet dysfunction.Objective and methodA clinical case was followed and reviewed to illustrate the possible connection between the withdrawal of duloxetine and the ongoing use of olanzapine with pulmonary embolism.ResultsA 36-year- old male, smoker of 30 cigarettes/day had been under treatment with olanzapine 30 mg/day and aripiprazole 30 mg/day for the past year. Duloxetine 90 mg/day had also been added for the past nine months and withdrawn after the improvement of depressive symptoms. Approximately one month after its withdrawal the man suffered pulmonary embolism and was hospitalised. During hospitalisation tests found no other factors predisposing to emboli creation. He was discharged with acenocumarol (Sintrom). His psychiatric medication was therefore adjusted to omit olanzapine and SSRIs /SNRIs because of their potential effect on coagulation.ConclusionsCan it be that olanzapine played a role in promoting pulmonary embolism in this patient ?Can it be that duloxetine was playing a protective role and its withdrawal facilitated the onset of pulmonary embolism? There is no certain way to tell but, to our knowledge, there has not been a similar case before and the time sequence of the events might not be coincidental.

scholarly journals Convulsive syndrome. Part 1

2021 ◽  
pp. 98-105
Author(s):  
P.V. Moskaleva ◽  
◽  
N.A. Shnayder ◽  
M.M. Petrova ◽  
R.F. Nasyrova ◽  
...  
Keyword(s):  
Medical Education ◽  
General Practice ◽  
Continuing Medical Education ◽  
Postgraduate Training ◽  
Medicinal Products ◽  
The Past ◽  
Epileptic Syndromes ◽  
Threatening Condition ◽  
Life Threatening ◽  
Convulsive Seizures

Convulsive syndrome is an urgent, potentially life-threatening condition in neurological, paediatric and general practice. Over the past decade, reconsideration has been committed in relation to the defi nition of epilepsy, epileptic syndromes, including convulsive syndrome with simultaneous expansion of the arsenal of medicinal products for cessation of convulsive seizures in children and adults. In this connection, we have prepared this lecture comprising two parts: the first part considers the defi nition, pathogenesis, aetiology and diagnosis of the convulsive syndrome. The lecture is designed for neurologists, paediatricians, general practitioners, ambulance physicians and anaesthesiologists-reanimatologists. Th e system of continuing medical education (CME) considers convulsive syndrome within the framework of the programme for postgraduate training of physicians in these specialities.

scholarly journals Cardiogenic shock and acute kidney injury: the rule rather than the exception

2020 ◽  
Author(s):  
N Ghionzoli ◽  
C Sciaccaluga ◽  
GE Mandoli ◽  
G Vergaro ◽  
F Gentile ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiogenic Shock ◽  
Severe Depression ◽  
Kidney Injury ◽  
Cardiorenal Syndrome ◽  
Current Evidence ◽  
Evidence Based ◽  
Threatening Condition ◽  
Life Threatening ◽  
Worse Prognosis

Abstract Cardiogenic shock (CS) is a life-threatening condition of poor end-organ perfusion, caused by any cardiovascular disease resulting in a severe depression of cardiac output. Despite recent advances in replacement therapies, the outcome of CS is still poor, and its management depends more on empirical decisions rather than on evidence-based strategies. By its side, acute kidney injury (AKI) is a frequent complication of CS, resulting in the onset of a cardiorenal syndrome. The combination of CS with AKI depicts a worse clinical scenario and holds a worse prognosis. Many factors can lead to acute renal impairment in the setting of CS, either for natural disease progression or for iatrogenic causes. This review aims at collecting the current evidence-based acknowledgments in epidemiology, pathophysiology, clinical features, diagnosis, and management of CS with AKI. We also attempted to highlight the major gaps in evidence as well as to point out possible strategies to improve the outcome.

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